Locally Commissioned Services report

Transcription

1 Locally Commissioned Services report Locally Commissioned Services are services that have been agreed locally between the CCG and our practices to meet the identified needs and priorities of our population. These were originally developed for the financial year 2013/14; these services have not been reviewed since. The table below details the Locally Commissioned Services for the year 2015/16, specifications whose text is highlighted in red reflect specifications where significant change has/will occur. Annual Development Plan Part 1 Annual Development Plan Part 2 Ambulatory Blood Pressure Monitoring Chronic Obstructive Pulmonary Disease Diabetes Ring Pessary TB Service ( BCG LES) Choose and Book End of Life Care Phlebotomy Zoladex Prevention Ordering or undertaking investigations for patients under hospital care Treatment of minor injuries (e.g. laceration capable of simple closure, bruises, superficial burns, minor head injuries with no loss of consciousness, including removal of foreign bodies) Provision of hormone implants Pregnancy testing where immediately necessary for diagnostic purposes Audiometry Twelve lead ECGs Booking of transport for patients Venous Leg Ulcer Dressings in Primary Care Management Of Complex And Secondary Care Wounds Shared Care Drug Monitoring Annual Development Plan Part 1 Progress made during 2016/17 The annual development plan specification contains a mix of services and processes that did not fit neatly into one of the other specifications. It has always been recognised as a bit of a mix and provided a price that has possibly not reflected the work undertaken. This specification has remained in its current format until plans for stand-alone specifications have been developed and agreed, below details the intention for each individual element.

2 Ordering or undertaking investigations for patients under hospital care o The steering group has agreed this service can be decommissioned. Treatment of minor injuries (e.g. laceration capable of simple closure, bruises, superficial burns, minor head injuries with no loss of consciousness, including removal of foreign bodies) o This service is to be re-commissioned in the form of a new service which will incorporate Venous Leg Ulcer dressings in Primary care and Management of Complex & Secondary Care Wounds, please see these specifications for further details. Provision of hormone implants o This was made a stand-alone specification, see Zoladex. Pregnancy testing where immediately necessary for diagnostic purposes o The steering group has agreed this service can be decommissioned due to pregnancy testing being widely available to the public. Audiometry o This is a PMS KPI, as such this is to be decommissioned from the LCS and it is being reviewed as part of the PMS Task & Finish group work. Twelve lead ECGs o This is to be developed into a standalone LCS, practices are to be remunerated for individual tests which are carried out. Booking of transport for patients o The intention is to commission this service through GP Chambers, practices will provide patients with the number to contact to arrange transport for their first outpatient appointment. Annual Development Plan Part 2 These specifications have continued to be commissioned, they have been commissioned as individual specifications, there are amendments to be made moving forward. Venous Leg Ulcer Dressings in Primary Care Management Of Complex And Secondary Care Wounds Both of these specifications have continued with the same specification as in 2014/15, the Steering Group has agreed both of these services and Treatment of Minor Injuries can be commissioned as one specification. Rather than payment for individual elements practices will be remunerated for time needed for consultations as described below:

3 10 Minute nurse consultation Minute nurse consultation Minute nurse consultation Minute nurse consultation Minute GP & nurse consultation Minute nurse consultation Shared Care Drug Monitoring This specification is currently undergoing review. A risk has been identified by GPs and Practice Managers that there is an ongoing increase in the drugs placed on the shared care list, without an increase in resource to manage this. Representatives from the CCG Medicines Management Committee have provided insight of how drugs are added to the shared care list, through these discussions it has highlighted that the Medicines Management Committee are not responsible for commissioning or monitoring how resource are reallocated to reflect this. Work is on-going to quantify the demand that has been placed on primary care as a result and the change in demand at the acute trusts with who the shared care agreement is held. Ambulatory Blood Pressure Monitoring The aim of this service is to provide equitable access to 24hr ABPM in a primary care setting; service providers will offer 24ABPM in a timely and convenient manner, thereby reducing referrals into secondary care. Chronic Obstructive Pulmonary Disease (COPD) This enhanced service is designed to build on the current GP contract to support practices to ensure their patients with COPD receive personalised care both in and out of hours from any health professional, as well as patients given information about their condition in order to allow them to take the initiative to prevent exacerbations of the disease. This has continued to be commissioned with an increase on the previous price to reflect inflation; the only amendment to this specification is the removal of the payment for the annual audit, it had been identified that there was no benefit to practices undertaking this work and reporting it to the CCG. Diabetes This enhanced service is designed to build on the current GP contract; the service specification is intended to ensure further specialised services can be provided to these patients.

4 Ring Pessary The specification of this service is designed to cover the enhanced aspects of clinical care of the patients, all of which are beyond the scope of essential services. This service was developed in partnership with Kingston Hospital consultants in order to reduce the prevalence of routine outpatient attendance. TB Service (BCG LES) The aim of this service is to provide an easily accessible, regular, Practice led clinic to the population of Kingston, offering a comprehensive service for BCG vaccination. This has continued to be commissioned without any amendments. Choose and Book This service allows Practices to provide patients a choice when they require a secondary care appointment to be booked through the national ereferral system. This has continued to be commissioned for 2016/17, it has been renamed as the ereferral LCS to reflect the work practices are undertaking, this service is to be reviewed for 2017/18. End of Life Care The aim of this Enhanced Service is to support the Joint RBK and Kingston CCG End of Life Strategy, and improve the quality of community palliative care to provide a holistic approach to patient needs; this applies to all patients including those in Nursing and Residential Homes. This specification has been amended; previously remuneration was only released to practices for the addition of patients to the Coordinate My Care register. The new specification which has been agreed for quarter 3 and 4 of 2016/17, the new specification remunerates practice for: 1. Identification Patients assessed as being in the last 12 months of life are entered on to the palliative care register. 2. Completed template Practices have a conversation with patients identified; this includes early identification of their carer. 3. Record uploaded/shared Record is uploaded on to CMC available to be viewed by all (nonpayment for patients registered by other providers). Post death audit completed automatically by CMC. OR Template is shared via an alternative method. Post death audit completed

5 Phlebotomy This service has been commissioned to ensure phlebotomy services are readily available in primary care and to provide an equitable, convenient service closer to home for the patient as well as ensure appropriate use of skills within general practice. Zoladex Zoladex (generic name goselerin) is used primarily, though not exclusively, in the treatment of carcinoma of the prostate, mainly for the treatment of metastatic cancer of the prostate. This has continued to be commissioned without any amendments. Prevention Risk Stratification Kingston CCG had previously deployed a Risk Stratification tool within Kingston, usage and uptake of this tool was low due to the limited functionality and data sources of the tool. The provider of the previous Risk Stratification Tool withdrew from the market as of 1 st April 2016; this enabled the CCG to procure a new tool. For Q3 & 4 practices will be remunerated for one named GP and Practice Manager to have training, answer questions regarding their population and provide feedback to inform how the tool could best be utilised for 2017/18 and beyond. Using this new tool the CCG has the ambition to measure how our LCSs support the improvement of patient health. NHS Diabetes prevention Programme The National Diabetes Prevention Programme (NDPP) is the largest national health prevention education programme to be undertaken in the world it is centrally funded by NHS England, who selected 4 Providers nationally. These Providers will work to a centrally developed national service specification; which stipulates all elements of delivery including reporting and referral criteria. In order to actively identify individuals who could benefit from the programme it has been agreed practices have run a search to identify them and will receive remuneration for inviting eligible patients to attend the programme initially through a letter from a practice, and then through following up through any means of the practice s choice. Practices will also receive remuneration for patients who do attend the programme.

6 Monitoring of Locally Commissioned Services Quality Medical Solutions LTD (QMS) currently provide the CCG with a service which runs quarterly reports for practices to inform them of their activity which they can provide for remuneration. When specifications are amended, resulting in new searches needing to be developed, this equates to an amendment in the contract that comes at a financial cost to the CCG. All practices within Kingston are now using the same clinical system, EMIS web, this represents an opportunity for the CCG as there is the opportunity to deploy the tool EMIS Enterprise. This will allow the CCG to develop in collaboration with practices to develop our own searches, resulting in a more efficient and flexible method for monitoring the LCSs. This tool forms part of the CCGs bid for the Estates and Technology Transformation Fund bid.